Reflections, Reconciliation & Repsychopathologization | Beyond Gender 2025 Year in Review
1 January 2026
Global
Stella O'Malley, Mia Hughes and Dr Bret Alderman review a pivotal 2025 without a guest: the For Women Scotland Supreme Court ruling, NHS England's puberty blocker clinical trial, Trump's executive orders, a damning HHS report, and Canada's refusal to reverse course. Drawing on their backgrounds in psychotherapy and research, they assess what the accumulating evidence now demands of health systems, courts and governments — and where the fault lines will run in 2026.
In this year-end episode, Stella O'Malley, Mia Hughes and Dr Bret Alderman sit together without a guest to take stock of twelve months that tested whether governments, health systems and courts would follow the evidence on gender medicine. The result is a candid audit of 2025: what moved, what stalled, and what the accumulating record of reviews, rulings and clinical reports now demands. In the United Kingdom, the year produced two developments of particular weight. The Supreme Court's ruling in For Women Scotland confirmed that the word "woman" in the Equality Act 2010 refers to biological sex — a clarification with direct consequences for single-sex spaces, services and official statistics. Alongside it, NHS England pressed ahead with the randomised controlled trial of puberty blockers for children with gender dysphoria, the clinical study recommended by the Cass Review as the only ethical route to generating reliable evidence. These two threads — legal clarity on sex and rigorous clinical scrutiny of medical interventions — represent exactly the kind of institutional correction the Cass Review demanded. Across the Atlantic, the new Trump administration moved quickly with executive orders touching gender policy at the federal level, while a report from the Department of Health and Human Services added to the international body of literature questioning the evidence base for paediatric gender medicine. Taken alongside the Cass Review and the guideline reversals in Finland, Sweden and Denmark, the American material reinforces a pattern: systematic evidence reviews, when conducted rigorously, consistently return the same verdict about the weakness of the underlying research. Canada stands out in the opposite direction. Where other anglophone countries have slowed, scrutinised or reversed course, Canada's institutions appear to be holding their previous position. The episode examines why some health authorities and governments continue to resist the converging evidence, and what professional and political incentives sustain that resistance even as the international consensus shifts beneath them. The word "repsychopathologization" in the episode's title signals something important about the intellectual terrain of 2025. It names the accusation levelled at those who argue that returning gender dysphoria to a psychological and psychotherapeutic frame — rather than a primarily medical one — amounts to stigmatisation. The hosts, drawing on their backgrounds in psychotherapy and research, push back on that framing and argue that taking psychological distress seriously through therapeutic support is precisely what the evidence and the patients require. This debate runs through the Cass Review, through NHS England's commissioning decisions, and through the conversion therapy law consultations that remain unresolved in Westminster. Looking ahead to 2026, the hosts identify the fault lines that matter: whether the UK puberty blocker trial produces the independent evidence it is designed to generate, whether Parliament legislates on conversion therapy in a way that protects legitimate therapeutic exploration, and whether holdout jurisdictions eventually align with the evidence. The episode stops short of declaring 2025 a clean turning point, but it makes clear that the documentation now exists and that institutions which continue to ignore it face mounting pressure to justify that choice.
